By that logic, a 160-pound man should consume around 160 grams of protein a day—the amount he'd get from an 8-ounce chicken breast, 1 cup of cottage cheese, a roast-beef sandwich, two eggs, a glass of milk, and 2 ounces of peanuts.) If you don't eat meat for ethical or religious reasons, don't worry — you can count on other sources, too. Soy, almonds, lentils, spinach, peas, and beans are packed with protein.
These complete proteins include all of the essential amino acids that the body cannot produce itself. Different proteins, such as whey and casein, egg and soy have different absorption rates. Whether you should favor one over another for muscle building is still a subject of popular and scientific debate, although whey protein isolate, a more rapidly absorbed protein, has some support from various scientific studies. For protein powders, assess the value by checking out the protein listed on the label. Combined with resistance training, sufficient protein consumption along with an appropriate diet can lead to increased muscle and reduced body fat. You should read more about The Bodybuilding Diet for supplement timing issues before and after training. 
The first open label trial on ALS failed to significantly alter lung function as assessed by FEV (when comparing the rate of decline pretreatment relative to treatment).[545] Creatine has elsewhere failed to benefit lung function at 5g daily for months relative to control[546] and failed to significantly attenuate the rate of lung function deterioration over 16 months at 10g daily[505] and 5g daily over nine months.[507]
The genealogy of lifting can be traced back to the beginning of recorded history[1] where humanity's fascination with physical abilities can be found among numerous ancient writings. In many prehistoric tribes, they would have a big rock they would try to lift, and the first one to lift it would inscribe their name into the stone. Such rocks have been found in Greek and Scottish castles.[2] Progressive resistance training dates back at least to Ancient Greece, when legend has it that wrestler Milo of Croton trained by carrying a newborn calf on his back every day until it was fully grown. Another Greek, the physician Galen, described strength training exercises using the halteres (an early form of dumbbell) in the 2nd century.
A muscle imbalance—when one muscle is stronger than its opposing muscle—can limit your ability to exercise effectively, and could lead to injury down the line. “It’s important to recognize whether you’re really working the muscles you think you are and recognize if you’ve developed an imbalance that alters your movement pattern,” says Eric Ingram, physical therapist at Louisiana Physical Therapy Centers of Pineville. One common imbalance in women is stronger quads and weaker, tighter hamstrings, thanks to prolonged sitting, high heels, and improper training. If you suspect you have a muscle imbalance, make an appointment with a physical therapist, who will prescribe exercises to even you out.
Does magnesium relieve migraines? Many people use magnesium, which is a naturally occurring mineral, to treat and prevent migraine headaches, especially those with aura. In this article, learn about the effectiveness of magnesium and discover whether there are any side effects or risks. We also list some of the foods that contain magnesium. Read now
2-[carbamimidoyl(methyl)amino]acetic acid, Cr, Creatin, Creatina, Créatine, Créatine Anhydre, Creatine Anhydrous, Creatine Citrate, Créatine Citrate, Creatine Ethyl Ester, Créatine Ethyl Ester, Creatine Ethyl Ester HCl, Créatine Ethyl Ester HCl, Creatine Gluconate, Creatine Hydrochloride, Créatine Kré Alkaline, Creatine Malate, Créatine Malate, Creatine Monohydrate, Créatine Monohydrate, Créatine Monohydratée, Creatine Pyroglutamate, Créatine Pyroglutamate, Creatine Pyruvate, Créatine Pyruvate, Dicreatine Malate, Dicréatine Malate, Di-Creatine Malate, Éthyle Ester de Créatine, Glycine, Kreatin, Kre-Alkalyn Pyruvate, Malate de Tricréatine, N-(aminoiminométhyl)-N-Méthyl, N-(aminoiminomethyl)-N methyl glycine, N-amidinosarcosine, Phosphocreatine, Phosphocréatine, Tricreatine HCA, Tricréatine HCA, Tricreatine Malate, Tricréatine Malate.

Second, strength training has a much greater level of excess post-exercise oxygen consumption than aerobic exercise.  What does this mean?  When you finish a workout, your body needs to do a lot of work to replenish itself in order to bring itself back to a normal state (the way it was before you worked out).  This takes a lot of energy, and some studies have shown that it can boost your metabolism for up to 38 hours after you finish your workout.
Creatine, which is synthesized in the liver and kidneys, is transported through the blood and taken up by tissues with high energy demands, such as the brain and skeletal muscle, through an active transport system. The concentration of ATP in skeletal muscle is usually 2–5 mM, which would result in a muscle contraction of only a few seconds.[22] During times of increased energy demands, the phosphagen (or ATP/PCr) system rapidly resynthesizes ATP from ADP with the use of phosphocreatine (PCr) through a reversible reaction with the enzyme creatine kinase (CK). In skeletal muscle, PCr concentrations may reach 20–35 mM or more. Additionally, in most muscles, the ATP regeneration capacity of CK is very high and is therefore not a limiting factor. Although the cellular concentrations of ATP are small, changes are difficult to detect because ATP is continuously and efficiently replenished from the large pools of PCr and CK.[22] Creatine has the ability to increase muscle stores of PCr, potentially increasing the muscle’s ability to resynthesize ATP from ADP to meet increased energy demands.[23][24][25]
Translation: your muscles are going to have more energy. The process of accessing that energy is so complicated, you almost need an organic chemistry degree to totally understand it. Yes, it’s complicated, but completely necessary for biochemical reactions like muscle contractions. And the more your muscle works, the more ATP is depleted and needs to be replaced for you to make progress toward your goals. With creatine supplementation, you can enhance your ATP regeneration and thus delay onset of muscle fatigue and work more intensely for a longer period of time. Little goes a long way in the pursuit of muscle gains.
Heart Failure is one of the single most common complications that face many people today. When a heart ages, the cells collect a yellow-brown layer which is waste and can lead to heart complications. This process is known as lipofuscin, or “aging pigment” which leads to death opposed to someone who can delay that as far as possible. [3] In mice, a study was performed where two groups of mice who had lipofuscin underwent different experiments, one group received creatine supplementation, and one group did not receive supplementation. What they found was that the mice who supplemented creatine lived 9% longer than the ones who did not receive creatine. 9% translated into human years results in almost 7 years, which could suggest that if you suffer from this deterioration, creatine supplementation could potentially increase your longevity by 7 years. [3]

The process of phagocytosis (a macrophage consuming a pathogen) in macrophages appears to be associated with an acute reduction in creatine phosphate stores (45%)[436] and an increase in creatine kinase activity,[290] although prolonged stimulation is met with an increase in creatine phosphate (20%).[290] The creatine kinase activity does not appear to be altered based on creatine availability,[290] but since ATP seems to be preserved in these instances,[436][290] the increase in phosphocreatine may be explained by an overall creatine pool paralleling that found in medium.[290]

Sculthorpe et al (2010) has shown that a 5 day (25g/d) loading protocol of creatine supplementation followed by a further 3 days of 5 g/d negatively influence both active ankle dorsiflexion and shoulder abduction and extension range of movement (ROM) in young men. There are two possible theories to explain these effects: 1) Creatine supplementation increases intracellular water content resulting in increased muscle stiffness and resistance to stretch; 2) Neural outflow from the muscle spindles is affected due to an increased volume of the muscle cell. The authors highlight that the active ROM measures were taken immediately after the loading phase and the reduced active ROM may not be seen after several weeks of maintenance phase [45]. Hile et al [46] observed an increase in compartment pressure in the anterior compartment of the lower leg, which may also have been responsible for a reduced active ROM.
As a ingredient that has been tested time and time again and shown to positively affect the building of muscle, GAT has taken the highest-quality compound to create Essentials Creatine. Using HPLC-tested pharmaceutical grade creatine that's tested to be 99.9% pure, Essentials Creatine provides 5 grams in every serving which can increase muscle size, boost strength, and enhance muscle recovery. Keep Reading »
Other areas of research include therapeutic uses of creatine to help patients with muscle wasting caused by disease states such as muscular dystrophy and amyotrophic lateral sclerosis (ALS). Small-scale preliminary studies show some gains in strength may be possible for these patients, which could improve their quality of life. One study of 81 patients with various neurologic diseases found that giving 10 g/day of creatine for five days, followed by 5 grams for another week, increases their muscle strength by about 10% [20]. Large-scale studies should be done before recommendations are made to such patients.
The concentration in healthy controls (57+/-8 years) without supplementation of creatine appears to be around 1.24+/-0.26µM per gram of hemoglobin[292] and appears to decrease in concentration during the aging process of the erythrocyte.[294][295][296] Otherwise healthy subjects who take a loading phase of creatine (5g four times daily for five days) can experience a 129.6% increase in erythrocytic creatine concentrations from an average value of 418µM (per liter) up to 961µM with a large range (increases in the range of 144.4-1004.8µM),[297] and this effect appears to correlate somewhat with muscular creatine stores.[297]
Higher percieved effort during heat (or due to elevations in body heat) are thought to be mediated by either the serotonergic system (suppresses performance)[388] or the dopaminergic system (enhances performance),[389][234] and creatine is thought to be involved in percieved effort during heat training since it has been noted previously to interact with neurotransmission by enhancing both serotonergic[253] and dopaminergic[230] neurotransmission.
Cyclocreatine appears to be passively diffused through membranes and not subject to the creatine transporter, which can be beneficial for cases where creatine transporter function is compromised (creatine non-response and SLG6A8 deficiency). Similar to other forms of creatine, it buffers ATP concentrations, although its efficacy as a supplement in otherwise healthy people is currently unknown.
 Besides the obvious benefits of getting protein into your system, our vegan protein powder offers other benefits too. It’s one of the one of the best bodybuilding supplements for anyone –– regardless of their diet –– because it’s a Smooth Protein™. That means it’s organic, non-GMO, gluten-free, and non-allergenic, and it also doesn’t have that gritty texture and earthy flavor associated with other plant-based protein supplements.
Creatine is used up as energy during high intensity exercise. Due to this usage, the amount of glucose required from glycogen is decreased a bit. This both preserves glycogen concentrations in skeletal muscle and reduces lactate production, which is produced when glucose is oxidized for energy. There do not appear to be any alterations in the bioenergetic status of muscle cells during low to moderate intensity exercise.
When lifting any weight, you’ve got a concentric (hard) and eccentric (easy) phase. For instance, as you lower into a squat, you’re performing an eccentric action. When you return to standing, that’s concentric. And, according to research published in the European Journal of Applied Physiology, eccentric work is far better at triggering hypertrophy.
Guanidoacetate (made by AGAT) then receives a methyl donation from S-adenosyl methionine via the enzyme guanidinoacetate methyltransferase (GAMT), which produces S-adenosylhomocysteine (as a byproduct) and creatine. Deficiencies in GAMT are more severe (although equally rare) relative to AGAT, resulting in severe mental retardation and autism-like symptoms.[31]
Another double-blind study supplemented with 18.75 g/day of creatine monohydrate for 5 days prior to high-intensity intermittent work to exhaustion, and then 2.25 g/day during testing. The workouts consisted of cycling to exhaustion using several protocols: (a) nonstop, (b) 60 seconds work/120 seconds rest, (c) 20 seconds work/40 seconds rest, and (d) 10 seconds work/20 seconds rest. Creatine supplementation significantly increased the total work time for all four protocols [13].
Athletes in ancient Greece were advised to consume large quantities of meat and wine. A number of herbal concoctions and tonics have been used by strong men and athletes since ancient times across cultures to try to increase their strength and stamina.[5] In the 1910s, Eugen Sandow, widely considered to be the first modern bodybuilder in the West, advocated the use of dietary control to enhance muscle growth. Later, bodybuilder Earle Liederman advocated the use of "beef juice" or "beef extract" (basically, consomme) as a way to enhance muscle recovery. In 1950s with recreational and competitive bodybuilding becoming increasingly popular Irvin P. Johnson began to popularize and market egg-based protein powders marketed specifically at bodybuilders and physical athletes. The 1970s and 1980s marked a dramatic increase in the growth of the bodybuilding supplement industry, fueled by widespread use of modern marketing techniques and a marked increase in recreational bodybuilding.
In nonelite swimmers conducting an intermittent sprint protocol (Six 50m sprints every two minutes), supplementation of a creatine loading period was able to reduce the decrement in speed during the third sprint (2% decrement rather than a 5% decrement) but not the sixth sprint. There were no changes in plasma lactate or other biomarkers of fatigue.[396] When examining a single 50m sprint in amateur swimmers, a creatine loading period is able to reduce the time to complete the sprint by 4.6%, while it had no benefit for the 100m sprint.[397] When the loading phase was followed by three weeks maintenance in youth, there was no apparent benefit to sprint performance (50m sprint with five minutes rest followed by a 100m freestyle) despite benefits to a swim bench test (30s sprints with a five minute break in between).[398]
Bodybuilders may supplement their diets with protein for reasons of convenience, lower cost (relative to meat and fish products), ease of preparation, and to avoid the concurrent consumption of carbohydrates and fats. Additionally, some argue that bodybuilders, by virtue of their unique training and goals, require higher-than-average quantities of protein to support maximal muscle growth.[19][20][21][22][23][24][25] However, there is no scientific consensus for bodybuilders to consume more protein than the recommended dietary allowance.[18][26] Protein supplements are sold in ready-to-drink shakes, bars, meal replacement products (see below), bites, oats, gels and powders. Protein powders are the most popular and may have flavoring added for palatability. The powder is usually mixed with water, milk or fruit juice and is generally consumed immediately before and after exercising or in place of a meal. The sources of protein are as follows and differ in protein quality depending on their amino acid profile and digestibility:
Three additional studies suggest that creatine supplementation may not be beneficial for running velocity, sprint swimming performance, or a maximal cycling effort [7]. Short bouts of repeated anaerobic activity have shown some potential benefits with creatine supplementation use in a laboratory setting. However, creatine supplementation has not been shown to enhance single-event performance such as stationary cycling [16-19]. Taken together, these studies do not support creatine supplementation to enhance aerobic activities such as distance running.
In females, the combination of SSRIs (to increase serotonin levels in the synapse between neurons) and creatine shows promise in augmenting the anti-depressive effects of SSRI therapy[230]. Another pilot study conducted on depression and females showed efficacy of creatine supplementation.[231] The one study measuring male subjects noted an increase in mood and minimal anti-depressive effects, but it is not know whether this is due to gender differences or the model studies (post-traumatic stress disorder).[232]
As mentioned, protein is essential for building muscle. If you are unable to consume the recommended amount of protein through diet alone, add protein powder for building muscle as a supplement. This applies to nearly anyone hoping to gain muscle mass since it’s not easy to pack in nearly 100 grams of protein a day through chicken, eggs and legumes alone.

Another supplement that’s ideal to take pre-workout is protein. Depending on your goals and your workout time, taking protein before your workout can help you keep your energy levels elevated while working out. Make sure you give yourself at least an hour between the time you take your protein and your workout time so that your body has time to digest.

Tribulus Terrestris: A fruit from the Mediterranean, this supplement has been used in the Indian traditional medicine of Ayurveda. In addition to helping increase testosterone, many people take it to increase libido and as a cardioprotective aid. (10) Unfortunately, despite the fact that there are claims that tribulus terrestris can increase testosterone levels, studies don’t back up these claims.  There is some evidence, however, that it may improve athletic performance. If you want to choose one of the supplements for men, this should be your pick.
For beginners, your own body weight might be enough to get you started. However, it can be hard to challenge your body without any additional resistance, so to progress, you'll need some equipment. If you decide to strength train at home, you'll want to invest in some basics, such as resistance bands, weights, and an exercise ball. Try to have a range of weights: a light set (3 to 5 pounds for women, 5 to 8 pounds for men), a medium set (5 to 10 pounds for women, 10 to 15 pounds for men), and a heavy set (10 to 20 pounds for women, 15 to 30 pounds for men).
During the 1950s, the most successful and most famous competing bodybuilders[according to whom?] were Bill Pearl, Reg Park, Leroy Colbert, and Clarence Ross. Certain bodybuilders rose to fame thanks to the relatively new medium of television, as well as cinema. The most notable[according to whom?] were Jack LaLanne, Steve Reeves, Reg Park, and Mickey Hargitay. While there were well-known gyms throughout the country during the 1950s (such as Vince's Gym in North Hollywood, California and Vic Tanny's chain gyms), there were still segments of the United States that had no "hardcore" bodybuilding gyms until the advent of Gold's Gym in the mid-1960s. Finally, the famed Muscle Beach in Santa Monica continued its popularity as the place to be for witnessing acrobatic acts, feats of strength, and the like. The movement grew more in the 1960s with increased TV and movie exposure, as bodybuilders were typecast in popular shows and movies.[citation needed]

When creatine is absorbed it pulls water in with it, causing cells to swell. This “cell volumization” is known to promote a cellular anabolic state associated with less protein breakdown and increased DNA synthesis.[107][108][109] An increase in cellular viability assessed via phase angle (measuring body cell mass[110]) has been noted in humans during supplementation of creatine.[111]

When looking specifically at human studies, there has been a failure of creatine supplementation to induce or exacerbate kidney damage in people with amyotrophic lateral sclerosis (ALS). Subjects do not experience kidney damage for up to or over a year’s worth of supplementation in the 5-10g range.[505][506][507] Postmenopausal women,[517] people with type II diabetes,[518] people on hemodialysis,[313] otherwise healthy elderly,[519] young people,[454][520][521] and athletes do not experience kidney damage either.[324] Moreover, numerous scientific reviews on both the long- and short-term safety of supplemental creatine have consistently found no adverse effects on kidney function in a wide range of doses.[522][523][524][452][525][451][526][527] However, while doses >10 g/day have been found not to impair kidney function, there are fewer long-term trials using such high chronic daily intakes.[527]
Mitochondrial myopathies are a subgroup of mitochondrial cytopathies in which the skeletal muscle is negatively influenced. They are characterized by weaknesses in muscular function and energy metabolism.[547] These particular myopathies are thought to benefit from creatine supplementation, since creatine can help with some of the dysregulated energy production.[548]

The motor proteins actin and myosin generate the forces exerted by contracting muscles. Current recommendations suggest that bodybuilders should consume 25–30% of protein per total calorie intake to further their goal of maintaining and improving their body composition.[30] This is a widely debated topic, with many arguing that 1 gram of protein per pound of body weight per day is ideal, some suggesting that less is sufficient, while others recommending 1.5, 2, or more.[31] It is believed that protein needs to be consumed frequently throughout the day, especially during/after a workout, and before sleep.[32] There is also some debate concerning the best type of protein to take. Chicken, turkey, beef, pork, fish, eggs and dairy foods are high in protein, as are some nuts, seeds, beans, and lentils. Casein or whey are often used to supplement the diet with additional protein. Whey protein is the type of protein contained in many popular brands of protein supplements and is preferred by many bodybuilders because of its high Biological Value (BV) and quick absorption rates. Whey protein also has a bigger effect than casein on insulin levels, triggering about double the amount of insulin release.[33] That effect is somewhat overcome by combining casein and whey. Bodybuilders are usually thought to require protein with a higher BV than that of soy, which is additionally avoided due to its claimed estrogenic properties. Still, some nutrition experts believe that soy, flax seeds and many other plants that contain the weak estrogen-like compounds or phytoestrogens, can be used beneficially, as phytoestrogens compete with estrogens for receptor sites in the male body and can block its actions. This can also include some inhibition of pituitary functions while stimulating the P450 system (the system that eliminates hormones, drugs and metabolic waste product from the body) in the liver to more actively process and excrete excess estrogen.[34][35] Cortisol decreases amino acid uptake by muscle, and inhibits protein synthesis.[36]
JAK2 (Janus-Activating Kinase 2) is a novel protein that has been shown to suppress the activity of the creatine transporter CrT in vitro. The effects of JAK2 on CrT are not well-understood in vivo, however. Given that growth hormone activates both c-src (increases CrT activity) and JAK2- which has been found to decrease CrT activity, it is plausible that JAK2 may function as a negative-feedback regulator of creatine uptake. Future research is needed to better understand the role of JAK2 on CrT activity in vivo.
In a pilot study on youth with cystic fibrosis, supplementation of creatine at 12g for a week and 6g for eleven weeks afterward was associated with a time-dependent increase in maximal isometric strength reaching 14.3%, which was maintained after 12-24 weeks of supplement cessation (18.2% higher than baseline).[485] This study noted that more patients reported an increase in wellbeing (9 subjects, 50%) rather than a decrease (3, 17%) or nothing (6, 33%) and that there was no influence on chest or lung symptoms.[485]
^ Kreider RB, Kalman DS, Antonio J, Ziegenfuss TN, Wildman R, Collins R, Candow DG, Kleiner SM, Almada AL, Lopez HL (2017-06-13). "International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine". Journal of the International Society of Sports Nutrition. 14: 18. doi:10.1186/s12970-017-0173-z. PMC 5469049. PMID 28615996.
Most people require around 20 calories per pound (or 44 kcal / kg) of bodyweight to gain muscle mass. Using a 180-pound (82kg) male as an example, the required daily calorie intake is 3600 calories (20 kcal x 180 lb = 3600 kcal). When it comes to gaining weight, it is likely that you may put on a few pounds of fat along the way, but if you do find your body fat increasing, either increase the amount of aerobic exercise (moderate intensity) you are doing or slightly reduce the total number of calories you are consuming. Remember you can’t force feed muscle gain!
Make no mistake: Eating for muscle is just as important as lifting for muscle. The foods you grab in the morning on the way to work, the meals you pack for lunch and mid-afternoon, what you put into your body immediately following your workout, and your final meal of the day impact your results as much as, if not more than, the number of reps you squeeze out at the end of a set. But in reality, it can be tough to stick to a "“clean"” diet when you'’re busy. We know that adding another layer of complexity to life in the form of reading food labels and studying ingredient lists just isn'’t an option for most of us. Not to mention actually preparing all those healthy meals.
If you are referring to how many pushups to do in one session, the short answer is as many as you can. Aim for a number that challenges you but is still realistic. Build up from day to day to increase muscle strength. If you are referring to how long you should do pushups as a form of exercise, that is up to you. Pushups are a good part of a long-term or permanent exercise regimen. Remember that if you stop doing them, your muscles will weaken.

A double-blind study provided 20 g/day of creatine monohydrate for 5 days to qualified sprinters and jumpers who performed 45 seconds of continuous jumping and 60 seconds of continuous treadmill running. Supplementation enhanced performance in the jumping test by 7% for the first 15 seconds and 12% for the next 15 seconds, but there was no difference for the final 15 seconds. There was a 13% improvement in the time of intensive running to exhaustion [12].

Creatine supplementation often causes weight gain that can be mistaken for increase in muscle mass. Increasing intracellular creatine may cause an osmotic influx of water into the cell because creatine is an osmotically active substance [10]. It is possible that the weight gained is water retention and not increased muscle. The retention of water may be connected to reports of muscle cramps, dehydration, and heat intolerance when taking creatine supplements. It would be prudent to encourage proper hydration for creatine users. Further research is needed to investigate these and other possible side effects.
The muscle endurance objective is pursued when you want your muscles to be able to perform the same motions over an extended period of time or in other words when you want your muscles to be strong and not become tired rapidly. You'll want to use at least 4 sets from which at least 16 repetitions are performed. The muscle endurance objective is often used for muscles in your lower body, such as those located in your legs or your buttocks.

Some people do have allergies to soy, or they have an intolerance to soy. If you notice certain symptoms (like a headache) after soy consumption, you may have an intolerance. Discovering your food intolerances/allergies would also be handled by a Dietitian. For the general population who are not allergic/intolerant to soy, however, soy-based products can be a part of a healthy diet. New research has shown that soy is not harmful as people fear. If soy gives you issues, you could always opt for whey protein, pea protein or other forms of vegetable protein. Have you seen our article on protein powders? Click here.
In a sample of people with colorectal cancer given creatine supplementation for 8 weeks to assess its interactions with chemotherapy, creatine failed to benefit muscle function or quality of life. Benefits were observed in body cell mass and phase angle (indicative of cellular viability), but only in the subsample with less aggressive chemotherapy.[111]
Peirano, R. I., Achterberg, V., Dusing, H. J., Akhiani, M., Koop, U., Jaspers, S., Kruger, A., Schwengler, H., Hamann, T., Wenck, H., Stab, F., Gallinat, S., and Blatt, T. Dermal penetration of creatine from a face-care formulation containing creatine, guarana and glycerol is linked to effective antiwrinkle and antisagging efficacy in male subjects. J.Cosmet.Dermatol. 2011;10:273-281. View abstract.
These effects were noted before in a preliminary study of depressed adolescents (with no placebo group) showing a 55% reduction in depressive symptoms at 4g daily when brain phosphocreatine levels increased.[231] Other prelimnary human studies suggest creatine might lessen unipolar depression[256] and one study on Post-Traumatic Stress Disorder (PTSD) noted improved mood as assessed by the Hamilton Depression Rating Scale.[232]